Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With Atrial Fibrillation in ENGAGE AF-TIMI 48

Abstract

Background: The ABC-stroke and ABC-bleeding risk scores incorporate clinical variables and cardiovascular biomarkers to estimate risk of stroke or systemic embolic events (S/SEE) and bleeding, respectively, in patients with atrial fibrillation (AF). These scores have been proposed for routine clinical use but their performance in external cohorts remains uncertain. Methods: ENGAGE AF-TIMI 48 was a multinational, randomized trial of the oral factor Xa inhibitor edoxaban in patients with AF and CHADS 2 score ≥2. We performed a nested prospective biomarker study in 8705 patients, analyzing baseline high-sensitivity troponin T (hsTnT), Nterminal B-type natriuretic peptide (NT-proBNP), and growth differentiation factor (GDF)-15, as well as in serial samples after 12 months. The ABC-stroke (age, prior stroke/transient ischemic attack, hsTnT, NT-proBNP) and ABC-bleeding (age, prior bleeding, hemoglobin, hsTnT, and GDF-15) scores were tested. Hazard ratios were adjusted for estimated glomerular filtration rate and the components of the CHA 2 DS 2-VASc and HAS-BLED scores, respectively. Discrimination and reclassification were compared with these established scores. Results: Median baseline hsTnT, NT-proBNP, and GDF-15 levels were 13.7 ng/L (25 th-75 th percentiles, 9.6-20.4 ng/L), 811 pg/mL (386-1436 pg/L), and 1661 pg/mL (1179-2427 pg/mL), respectively. Elevated hsTnT, NT-proBNP, and GDF-15 were independently associated with higher

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

“…and indices of atrial structural and functional remodeling obtained by various imaging tools have been shown to correlate with individual AF-related thromboembolic risk, and several biomarker-based stroke risk scores 26 have been validated, showing modest but statistically significant improvement in stroke risk prediction when biomarkers are added to clinical risk factors. 27 Recent evidence suggest that the burden of AF may be associated with thromboembolic risk and all-cause mortality. 28 Whereas the landmark trials of nonvitamin K antagonist oral anticoagulants versus warfarin for stroke prevention in AF consistently showed that the residual thromboembolic risk among anticoagulated patients was significantly lower in those with paroxysmal as compared with persistent AF even after adjustment for baseline characteristics, 29 data from earlier trials that included nonanticoagulated controls 30 and contemporary AF registries or population-based studies 31,32 are conflicting.…”

Evaluation of the Age, Biomarkers, and Clinical History–Bleeding Risk Score in Patients With Atrial Fibrillation With Combined Aspirin and Anticoagulation Therapy Enrolled in the ARISTOTLE and RE-LY Trials

“…Importantly, the ABC-bleeding risk score was also shown to be well-calibrated in several cohorts of patients with AF. 7 , 8 The ABC-bleeding score has, therefore, been mentioned in the recent European AF and Dual Antiplatelet Therapy guidelines 1 , 2 as a possible tool to estimate risk of major bleeding in patients with AF. In this cohort study, we evaluated whether the ABC-bleeding risk score might be useful to identify patients with different risks of bleeding during concomitant antiplatelet (aspirin) and anticoagulation therapy based on 9369 patients from the RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial 9 and 14 980 patients with AF from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial.…”

The impact of growth differentiation factor 15 on the risk of cardiovascular disease: evidence from Mendelian randomization study

“…Similar states that the incidence of any stroke could be predicted by GDF-15 in individuals with AF [43] and CVD [7,8]. In ENGAGE AF-TIMI 48 trial, GDF-15 levels from the baseline of 1661 pg/mL to 12 months of 1711 pg/mL were independently associated with a >2-fold higher rate of stroke or systemic embolic events in patients with AF [44]. Likely, during 1.9 years of follow-up, an annual rate of stroke or systemic embolic events was 2.03% in AF patients with GDF-15 in the highest quartile (>2052 ng/L) while 0.90% in the lowest quartile (≤977 ng/L) in ARISTOTLE trial [45].…”